A 47-Year-Old Woman With Progressive Dyspnea and Recurrent Pneumothoraces

Abstract

47-year-old woman was referred for evaluation of dyspnea and recurrent bilateral pneumothoraces, with the last episode requiring left apical resection and talc pleurodesis. The pathology from this procedure revealed only a scarred bleb lining. Dyspnea was described as insidious and gradually progressive since onset 5 years earlier. The medical history was notable for emphysema. The findings of a review of systems was otherwise negative, as was the family history. A social history revealed a 10 pack-year history of smoking with current use being described as sporadic. The physical examination findings were unremarkable with the exceptions of pulse oximetry values of 82% while breathing room air and a well-healed thoracotomy scar. The data available at the time of referral included normal serum chemistry levels, CBC, and 1-antitrypsin levels, along with pulmonary function test (PFT) results that revealed an FEV1 74% of predicted, FVC 97% of predicted, and FEV1/FVC ratio 62% of predicted. The diffusing capacity of the lung for carbon monoxide (Dlco) was also 27% of predicted.